The Treatment Of Hot Flashes

CLEVELAND (January 15, 2004) -- Treatment of hot flashes, especially those moderate to severe in intensity, has focused primarily on estrogen therapy. However, recent studies questioning the benefit-risk ratio of long-term estrogen use have increased attention to alternative treatments. To help clinicians and women make informed decisions regarding these therapies, The North American Menopause Society (NAMS) has created an evidence-based Position Statement titled, "Treatment of menopause-associated vasomotor symptoms." The report is published in the January/February issue of the NAMS journal, Menopause.

"NAMS is pleased to present these clinical practice recommendations," said Wulf H. Utian, MD, PhD, NAMS Executive Director. "This paper provides a valuable source of evidence regarding the potential benefits and risks as well as the scientific uncertainties of the various therapeutic options."

For women who need relief from mild hot flashes, NAMS recommends first considering lifestyle changes, such as strategies to keep the body cool, participating in regular exercise, and using paced respiration. These changes can be done either alone or combined with a nonprescription remedy, such as dietary isoflavones, black cohosh, or vitamin E. Even though the published evidence does not conclusively support the effectiveness of those remedies, short-term use does not cause serious harm.  For women with more severe hot flashes (either in number or intensity), estrogen-containing products are still the most effective treatment. Prescription drug alternatives include progestogens, the antidepressants venlafaxine, paroxetine, and fluoxetine, as well as the anticonvulsant gabapentin.

"Although the trials show estrogen works the 'best' for hot flash relief, head-to-head comparisons of estrogen to the other therapies were often not performed," said Nanette F. Santoro, MD, Chair of the Editorial Panel. "So, it's not really possible to prioritize the nonestrogen treatments in terms of their effectiveness compared with estrogen because the women studied could have differed in ways that made the medications appear either more or less effective."

Along with the recommendations, the Position Statement includes a review of hot flash incidence, factors related to hot flashes (eg, warm air temperatures, cigarette smoking, physical inactivity), and the physiologic changes that occur during a hot flash.

NAMS is North America's leading nonprofit organization dedicated to promoting women's health during mid-life and beyond through an understanding of menopause. The Society's unique multidisciplinary membership of more than 2,000 includes experts from medicine, nursing, sociology, psychology, anthropology, pharmacy, epidemiology, nutrition, education, and basic science -- helping NAMS to be the preeminent resource on all aspects of menopause to healthcare providers and the public. Its multidisciplinary membership of menopause experts also makes NAMS uniquely qualified to provide menopause-related information that is accurate, well-balanced, and presented without bias.

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Created: 1/24/2004  -  Donnica Moore, M.D.